Pulmonology Coding Alert

Single ICD-9 code transforms to ten codes in ICD-10.

When reporting acute bronchitis, you will need to look at the documentation to check for the etiology of acute bronchitis as this will carry weight when ICD-10 goes into effect. Here's how the reporting will differ from ICD-9 when ICD-10 hits.

ICD-9: There is only one code for acute bronchitis in ICD-9 irrespective of the etiology of the condition. At present, you will report acute bronchitis with 466.0 (Acute bronchitis)

ICD-10 difference: When ICD-9 transforms to ICD-10, you will modify your acute bronchitis coding from 466.x to J20.x. Don't forget the expanded ten codes under J20.x that describe the etiology of the condition in greater detail, including:

• J20.0 (Acute bronchitis due to Mycoplasma pneumoniae)
• J20.1 (Acute bronchitis due to Hemophilus influenzae)
• J20.2 (Acute bronchitis due to streptococcus)
• J20.3 (Acute bronchitis due to coxsackievirus)
• J20.4 (Acute bronchitis due to parainfluenza virus)
• J20.5 (Acute bronchitis due to respiratory syncytial virus)
• J20.6 (Acute bronchitis due to rhinovirus)
• J20.7 (Acute bronchitis due to echovirus)
• J20.8 (Acute bronchitis due to other specified organisms)
• J20.9 (Acute bronchitis, unspecified)

Note: J20.x will cover all cases of acute and subacute bronchitis along with acute tracheobronchitis but will not include allergic bronchitis (J45.0, Allergic bronchitis NOS) and all types of chronic bronchitis (J42, Unspecified chronic bronchitis; J41.0, Simple chronic bronchitis; J44.0, Chronic obstructive pulmonary disease with acute lower respiratory infection; J41.1, Mucopurulent chronic bronchitis). It also includes bronchitis NOS (Not otherwise specified) in those below the age of 15 years but does not include bronchitis NOS in patients above the age of 15 years (J40, Bronchitis, not specified as acute or chronic)

Documentation: With ICD-10, you will need to focus more on the cause of the acute bronchitis, so check the encounter notes for these details. If the documentation does not identify the etiology of the acute bronchitis, then you will have to report J20.9. "Be sure not to assign a definitive cause unless the physician confirms and documents the causal organism," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia. "Just as in ICD-9, do not assign a diagnosis if the physician references a causal organism as "suspected," "probable" or "possible."

Your pulmonologist will usually diagnose a case of acute bronchitis using the signs and symptoms that the patient is experiencing. Some of the common signs and symptoms that will you will see in the documentation will include fever (R50.9, Fever unspecified), malaise (R53.81, Other malaise), nasal congestion, wheezing (R06.2, Wheezing) and dry or suppurative, persistent cough (R05, Cough).

Since most of the cases of acute bronchitis are of viral origin and are self-limiting, the management will only involve treatment of symptoms that the patient is experiencing. If there is significant amount of sputum formation, then your pulmonologist might suspect a lower respiratory tract infection (such as pneumonia) and order further tests such as a chest x-ray to rule out or confirm the condition.

Your pulmonologist might order a sputum culture to know the etiology of the condition. This will often be essential if your pulmonologist suspects a bacterial origin that will need treatment with antibiotics. If your pulmonologist has ordered a histopathological study, the etiology of the condition mentioned in the documentation will help determine the appropriate code that you can report for the case of acute bronchitis.

Example: A 20-year-old male patient arrives at your pulmonologist's office with complaints of severe persistent cough for a period of about ten days with moderate amounts of sputum production. He also complains of fever with chills, nasal congestion, generalized body and muscle aches during this period.

Upon examination, your pulmonologist arrives at an initial diagnosis of acute bronchitis. Here you will report a preliminary diagnosis as J20.9 as the etiology is not confirmed. Since he suspects a bacterial origin, he sends a sputum sample for culture. When results from histopathology arrive, it confirms an infection due to streptococcus. Since the etiology is confirmed, you will now report the condition using J20.2.